Ms. Tinh had two previous cesarean sections. In her current pregnancy, doctors at Tam Anh General Hospital Ho Chi Minh City diagnosed placenta accreta at 18 weeks. By 30 weeks, the placenta had invaded and was pressing against her bladder.

Placenta accreta is an obstetric complication classified into three types: accreta, increta, and percreta. Doctor of second-degree specialization Nguyen Ba My Nhi, Director of the Obstetrics and Gynecology Center, stated that Ms. Tinh had percreta, the most severe form, where the placental villi penetrate through the uterine muscle layer. This complication poses a life-threatening risk to both mother and baby if unexpected rupture of membranes occurs, leading to uncontrollable bleeding.

Doctors anticipated Ms. Tinh might experience preterm labor and prescribed medication to aid fetal lung maturation, while also preparing to control massive bleeding – the most dangerous complication of placenta accreta. Normally, after birth, the placenta detaches naturally. However, with placenta accreta, the placenta cannot detach, leading to postpartum hemorrhage. Beyond the risk of bleeding, patients are also susceptible to bladder and ureter damage during surgery.

Doctor of second-degree specialization Thi Van Gung, Deputy Director of the Interventional Vascular Center, evaluated this as a major, high-risk surgery. Conventional surgical methods would result in significant blood loss for the patient. The endovascular intervention team and the surgical team agreed to place internal iliac artery occlusion balloons immediately before the cesarean section.

According to Doctor Gung, Ms. Tinh was the first patient to undergo this procedure at Tam Anh Hospital.

Doctor Gung and the interventional team placed internal iliac artery occlusion balloons before Ms. Tinh's cesarean section. *Photo: Trung Vu*

When Ms. Tinh was nearly 35 weeks pregnant, immediately before her cesarean section, bilateral internal iliac artery occlusion balloons were placed. With the assistance of a digital subtraction angiography (DSA) system, doctors threaded balloon catheters through her femoral arteries into both internal iliac arteries. The balloons were then inflated to calculate volume and verify position, after which they were deflated, the catheters secured, and Ms. Tinh was transferred to the operating room.

During the cesarean section, after the umbilical cord was clamped, these balloons were inflated to temporarily block blood flow to the uterus. They were then deflated just before closing the abdominal wall. The hospital had prepared 3 liters of blood as a precaution against maternal blood loss.

A healthy baby girl was born, weighing 2,4 kg. Doctor Nhi sutured the patient's uterine muscle without attempting to remove the placenta to prevent massive blood loss. The team inflated the occlusion balloons, sealing the vascular lumen to reduce blood supply to the uterus and placenta. This technique minimized the need for blood transfusions for the patient, thereby reducing the risk of disseminated intravascular coagulation (DIC) associated with large volume transfusions. Furthermore, blocking blood flow to the uterus provided surgeons with better visibility, facilitating the operation and limiting complications.

Doctor My Nhi performs a cesarean section for Ms. Tinh, with the baby delivered safely. *Photo: Trung Vu*

After more than 4 hours, the patient underwent a safe hysterectomy. Blood loss during surgery was only 1,5 liters, which was one-third of the predicted amount. Ms. Tinh received supplementary blood transfusions, recovered, and was discharged after one week.

Placenta accreta is a leading cause of postpartum hemorrhage and coagulation disorders, which can be fatal for the mother if not managed promptly. This complication is commonly seen in patients with prior cesarean section scars or a history of uterine surgery.

Doctor Nhi noted that the incidence of placenta accreta in women without uterine scars is approximately 0,03-0,08%. The risk increases significantly for those with a history of cesarean sections, cesarean scars, or placenta previa. The risk of placenta accreta is about 0,6% after one cesarean section, rising to 1,3% after two cesarean sections. Therefore, doctors advise undergoing a cesarean section only when there is a medical indication.

By Tue Diem

*Patient's name has been changed